LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Thursday, May 31, 2007

Blue isn’t always bad

Tonight is a Blue Moon. So I’m thinking the only solution is to drive over to the Blue Corn Cafe in Santa Fe and drink a Blue Margarita on their wonderful outdoor patio.

And while I’m there I might as well have some chips and queso. And guacamole. Maybe a quesadilla too. And they do make a pretty good chocolate volcano cake….

Better pop in a full reservoir before I go.

Friday, May 25, 2007

Stupid Foot Injury

Turns out practice what you preach is more than just a proverb. Or metaphor. Or what ever. It turns out it is (insert your favorite expletive) good advice.

So for over a year now I’ve been harping on my patients not to run around bare or sock-footed. They are all sick to death of my line “love your feet and they’ll love you back,” and my proposed bumper sticker: Be buried with all your toes: wear your slippers tonight!

I might be fuzzy on the exact number, but I recall that we have about 600 non-traumatic amputations each year in my state alone. Now, if you are the amputee, I can guarantee that all amputations are traumatic. But non-traumatic amputation is simply one that is medically necessary rather than the result of a car accident, lawn mower incident, dropped chainsaw or improvised explosive device. Thankfully, we have very few of the latter here in the Land of Enchantment.

That said, almost all of the 600 are diabetics. Nationwide, we D-folk lead the charge and are responsible for the vast majority of non-traumatic amputations.

So back to practicing what I preach. I had a looooooooooooong day. When I got home I sat down at my computer to check my emails and kicked my shoes off, too lazy to go find slippers first.

I stayed on the computer a little too long and subsequently had to make a dash for the bathroom where upon my foot missed the door opening and smacked full speed into the door jam.

On the bright side, the level 9 pain confirmed the recent monofilament test showing I have absolutely no reduced feeling in my feet whatsoever. What followed was a predictably un-dignified string of curses in five languages interspersed with pounding my fist on a counter top while hopping around on the remaining intact foot. So now I’m suffering from both a throbbing foot and a throbbing hand.

I don’t know why we men-folk do that: hit a counter top or a wall when we’ve hurt another part of the body. Maybe it’s to distract our animal brains from the pain. Yeah, good plan. You are in pain, so add more pain. There is probably only so much pain you can stand before your pain receptors are overloaded and you can’t feel a thing anymore.

So I feel stupid ‘cause I ran into a wall. And I feel stupid ‘cause I know better. And I feel stupid ‘cause I’m a (insert your favorite expletive) hypocrite. In this case a limping hypocrite with a dark purple toe to show for it.

Practice what you preach. Good words to live by.

Things that go bump in the night

(Sorry I was MIA for a bit guys, I’ve been soooooooooooo sick….But thanks to the Z-Pack and days of sleeping and watching Star Trek re-runs I’m ready to get back to life again.)

Things that go bump in the night don’t scare me, because it is most assuredly my little night owl up and about on some nocturnal mission of great importance to his five-year-old brain.

We all know that there are night people and day people. Rio is one of the former, as is his mother. She doesn’t even send off brain waves until 8 p.m.

When I was younger, my Mother, her mind ever active, use to speculate on why there were day people and night people. At first she postulated that maybe the night people were descendants of night watchmen who genetically altered after generations of duty on the city walls keeping watch over the slumbering inhabitants. After reading Von Danikin’s Chariots of the Gods in the late 60’s she thought maybe we were a mix of local apes and alien visitors who lost all sense of time after generations of interstellar travel with no sun, only endless night.

I use to be a night person too, before the necessities of life ruined me. In my late teens and early 20s I was a freelance photographer by day to feed the soul and a security guard by night to feed the body.

So Rio comes to life about 10pm. Well, actually, he’s a live wire from the minute he wakes up around noon until I am ready to kill him at 2 a.m. But, it is amazing to see the surge of pure energy that hits a couple of hours after the sun sets. Poor thing, he goes to school this fall. He’ll have to adapt his natural, genetic, God-given patterns to our society. My poor little alien night watchman.

Another thing that goes bump in the night, is, apparently, my liver. ParaPump discovered this. Maddingly, at different times between 1 a.m. and 4 a.m. I’m getting huge surges of sugar. Not the kind of adrenaline rush you’d expect from a nightmare about being eaten by lions, either. I’m talking about serious long-term production. Looking at my Carelink charts I find my self slow and steady at 114 or so post prandially for hours after dinner. When the rise kicks in it jets me up, up, up, up, up to the 180s or 190s just before my alarm forces my night-person self into modern reality. Yeah, six a.m., an hour not even fit for birds.

I keep throwing basal adjustments on the fire, but I haven’t mastered it yet. In fact, I can not yet convince myself I’ve done any good at all. Yet, that is. I down-load the ParaPump every week. Sit down with my coffee, the sensor overlay charts, and my food log and stare into my crystal ball and always ask the same question: What the f---- happened this week?

Friday, May 11, 2007


I’ve gotten use to entering BGs manually, so I’m only mildly annoyed now by the fact that I can’t use the BD Link meter as it was intended to be used.

In fact, I like the slimmer ParaPump so much more than my fat ‘ol CoZmo, that I’d say it was a fair trade on that basis alone.

Now that I’m in control of the calibration sticks the CGM is purring like a kitten. Finger sticks are so close to the readout on ParaPump that it is plum scary. Most of the time the finger sticks are with in 5-10 BG points of the SG (sensor glucose); except for during times of rapid hypos.

The MedT infusion sets are doing a great job too. My BG swings have settled down unbelievably. When I’m careful about what I eat, I can live days “between the lines.” Nuthin below 85 and nuthin above 200. Of course that assumes the Devil (or my sweet loving boss) doesn’t tempt me with brownies. Or mini Twix bars. Or home-made lemon cake, Danish wedding cookies, tootsie pops, dried pineapple, doughnuts, or….. well, you get the idea.

Thursday, May 10, 2007

Small, sexy, AND smart

I guess I was having a less than optimal night’s sleep. I must have tossed and turned more than usual, hopelessly entwining myself in the sheets and blankets. ParaPump and the seashell got separated by too many layers.

By some miracle the lost sensor alarm woke me up. At three fricken a.m.

Damn. Once a sensor gets a lost status most times you can’t bring them back. There was a huge expanse of blank nothing on my graph. Well, crap.

I untied the knots in the infusion hose and pulled it free from the twisted mess of sheets and covers. I smoothed the bed out by the blue glow of my clock and settled back into the bed to sleep. I’ll probably have to put in a new sensor come morning, I groaned to myself, then my head hit the pillow and I was gone.

In the morning ParaPump and the transmitter where happily chatting to each other again, to my delight.

As I scrolled back over the night’s data I got a shock. There was no missing data. For a moment I wasn’t sure: was the tangle of sheets and lost telemetry a dream? I checked the sensor alarm history, nope. The alarm was there.

So how come no missing data? Then it hit me like a lightning bolt: the transmitter must have a memory! I don’t remember reading anything about this in the MedT manuals. Maybe it was there and I missed it. This is a feature worth bragging about.

If you lose communication for a time, you have not lost your data. I guess the transmitter holds on to all those little data packets in its pockets until the next time it phones home. How very cool, but where on earth does it store them in that little tiny shell? Amazing stuff. Further proof that MedT stole the technology from aliens. ;-)

Wednesday, May 09, 2007

Basal Quest

I’m going to bed on target. In the morning I’m 160. Or 170. Or 159.

What the hell, you ask? AhHa! I have technology on my side. I can’t see into the future, but I can damn sure see into the past; and very clearly at that. This morning I hit the ESC key twice to view the 24 hour graph. There my sugar was, stable and coasting down all night until about three am. Then up, up, up climbs my blood sugar. I scroll back for the exact time, using the down arrow key. I park the flashing cursor over the exact moment in time when the graph starts to swing upwards. 2:56 a.m.

I don’t know the cause, but I know the solution. For years my nighttime sugars have been stable. Now my liver is working overtime while I’m snoozing. I’m probably being abducted by aliens in my sleep (they want that tiny little transmitter back!). Well, short of a cure, a good treatment is always the best medicine.

A three a.m. spike means the two a.m. basal needs to go up. I open ParaPal and up the basal steps in the wee hours of the morning. Then I plug the otherwise unused BD Link meter into my computer and beam the new program to the pump.

It is worth mentioning that it is almost impossible to get the CoZmo to talk to a computer. You have to use an infrared reader that doesn’t really work well at all (understatement of the year award). Before you get ready for your 7-10 tries to get it to work you have to peel off the leather case and remove your CozMonitor by unscrewing the battery cap with a nickel. The Monitor uses the same infrared ports the computer needs. CoZmo software is almost as good as the infrared reader. So there you have two more very good reasons to switch to MedT, beyond smaller size and integrated CGM.

The ParaPump, on the other hand, communicates quickly and with no headaches so long as you take their advice and get as far from the computer as you can. They give you enough cable to hang yourself. This last time I left the pump on my belt, set the meter in my lap and gave myself a good push from the desk. My chair rolled back into the middle of the library and I downloaded just fine. Of course, then I couldn’t reach my key board.

Back to the basal quest. In the old days (like two years ago); you would only know that sometime between your bedtime fingerstick and your wakeup fingerstick your basal was off. You’d have no clue when. If you set you alarm to wake yourself up every couple of hours you risk interfering with your own experiment. A three a.m. alarm gives most of us a shot of adrenaline.

With CGM nighttime basal tweaking is a breeze. You can snooze all night uninterrupted and ParaPump is on the case, dutifully recording your blood sugar every five minutes the entire time. You can get a quick look at the night on your pump’s screen, then you can download for advanced study. And you can adjust night after night, until you get it right.

Tuesday, May 08, 2007

The Hieroglyphics of Pumping

I think MedT’s use of Egyptian Hieroglyphics must be a salute to our heritage. After all, as D-Author and Educator Gary Scheiner reminds us in his book Think Like a Pancreas, the first recorded case of diabetes dates to a 1552 BC papyrus by the Egyptian physician Hersy-Ra. That’s Hersy, not Hershey.

And just where does MedT use hieroglyphics, you ask?

Glad you asked. In almost all of its important functions and status communiqués the ParaPump does not speak English, Spanish, French, or German. It uses ancient Egyptian.

When ParaPump is just minding it’s own business and doing its job, most of the screen that dominates its face is blank. The only signs of life are along a thin ribbon on the top of the screen. On the left is the missile with chevrons, then (sometimes) the full moon or the bull’s-eye, then, in the middle, up to four numbers. The numbers are modern, thank goodness, not Roman numerals. Next comes the toilet plunger (or in some cases the cookie cutter), and last the tank with boxes.

Confused? Luckily for all of you I attended the American University in Cairo in a previous life and I can still remember a great deal of the Hieroglyphics I learned.

Starting at the right, ‘cause sometimes hieroglyphics read right to left, we’ll start with the tank with boxes. This is the battery status icon. The number of boxes tells you about how much battery is left. In theory. The icon seems highly subjective and none to precise. Almost immediately after putting a fresh battery in it, I dropped from four to three boxes. That said I walked around for weeks with only one box left in the tank. The CoZmo battery icon had more precise graphic depiction of battery life. Some of my other battery powered gear can actually predict how much time remains on the battery.

That said, I’m tickled to have a battery icon of any kind. The original Guardian did not have one at all. It gave you an alarm moments before the battery died, almost always at two in the morning.

The toilet plunger and the cookie cutter are icons to indicate if and how well the seashell transmitter and the ParaPump are talking to each other. The toilet plunger shows a strong telemetry. The seashell is transmitting and the ParaPump is receiving. All is well with the world when the toilet plunger is on your screen. The cookie cutter warns you of trouble in paradise. Your sensor system is on, but there is no communication. Any number of things can cause this, most of them end badly. Every once in a while you’ll lose an info packet and get the cookie cutter for a short time, then it recovers. Most times, when you see the cookie cutter you know your life line is about to be cut off. So don’t eat cookies when you see the cookie cutter.

The numbers in the middle are the time. You can set 24 hour (sometimes called military time) or AM/PM time. I’ve got mine on 24 hour. Don’t know why, I have just always preferred it.

Next are the moon and the bull’s-eye. Just remember that when there is a bad moon rising you need to be careful; and when you are in the bull’s-eye you are in a world of shit. The moon icon indicates that an alarm condition exists. I’ve got a full moon rising on my screen right now. So what does that mean? Well it can mean a whole lot of things. In this case, it is because I’m a few hours from site change and my reservoir is low. Deb just pulled chocolate-chip banana bread (made with Splenda) out of the oven. Smells sooooooooooo good. I’ll need to get a new reservoir full of NovoLog into ParaPump before that bread cools off! The bull’s-eye means something so serious has happened that the pump is not working. I would have chosen an icon of a person screaming, myself. Oh, yeah, the bull’s-eye also shows up when you have suspended the pump.

Last, on the far left, is the missile with chevrons. This shows you more or less how much insulin is in the reservoir. Not too precise, because like the battery icon, it only has four “bars.” So more or less full, 75% full, half full, or only 25% or less left. Here is where I miss the CoZmo. It too had a little icon, but right below the hieroglyph it told you exactly how many units were left in the pump. I can menu surf and get that info from the ParaPump, but it takes work and I’m a busy guy. All diabetics are busy. We need simple.

So all of these Icons are things you can (and must) learn. I suppose they are no better or worse than any other pump. My biggest gripe is that we have this huge screen with nothing on it most of the time. We’ve got a huge blank screen on the most sophisticated, info packed pump of all time. Drives me fucking crazy. My fist choice would be for it to display the latest Sensor Glucose and a graph. Or the status of the power, reservoir, basal, last bolus, active insulin in your body….or all of the above. What the hell, we’ve got a pretty big screen. We’re using meaningless hieroglyphics; why not design an aircraft-style cockpit display? Something that, with practice, you can glace at and know everything you need to know about your pump and your blood sugar.

Maybe some people would never learn to use it, but it beats the hell out of a blank screen that benefits no one. Maybe it would eat up the batteries a little sooner. AAAs are cheap. I would rather change the battery every two weeks than every month if it gave me info at a glace. Info with out menu surfing.

Anyway, a toast to Hersy-Ra for trying. And a toast for MedT for succeeding, because even with all the things we hate, we’d hate even more to be living in pre-pump times, or worse yet in 1552 BC.

Monday, May 07, 2007

Storm warning

You know the storm is coming. The horizon turns dark grey. The sun disappears behind the clouds. Thunder booms through the canyons. The temperature drops and the wind kicks up, swirling the red dust between the Pinions and Junipers, and down into the arroyos.

There is an wild, electric feel to the air.

You know the storm is coming. And as it races across the mesas, virga sweeping down from the clouds to kiss the dry earth, the barometric pressure drops.

As you run for cover I have a quick science quiz for you: is 29.82 inches of mercury a high, average, or low barometric pressure reading? Ahhhh… how tricky NUMBERS can be. Would you rather someone told you the barometric pressure was low and falling, or would you rather someone gave you the current air pressure in inches of mercury with no trend information?

Well, I for one would rather be told, hey, it is low and dropping; than be given a single isolated number. But for some reason, most diabetics would rather know the specific single number than a general idea and the trend.

If someone tells me the barometric pressure is 29.82 I don’t know weather or not (intentional misspelling) to pack an umbrella. If I’m told it’s low and dropping I know the weather is going to hell.

Likewise, is it better to know that your sugar is exactly 70; or is it better to know that it is kinda low and falling?

Continuous Glucose Monitoring won’t always give you the exact number, and that pisses off a lot of folks. But it will give you the general vicinity, and more important, it will place that number into context by telling you the trend and direction. I promise you, that information is ultimately more important.

From years of no other choice, we are in the habit of studying beautiful, crisp, pristine Black-and-White photographs in a hushed art gallery called FingerSticks on the Plaza. What we are now given are grainy, low res color videos in a noisy movie theatre on a college campus called The CGM Tales. It takes some time to get use to it. It is a change and a challenge. It is a new way of thinking. And as time goes by the resolution of the video will get better and better. We are at the start of a beautiful revolution that will allow us to control our blood sugar, and therefore the destiny of our health better than we ever dreamed we could in the past.

So who cares what the barometric pressure is? The CGM in my ParaPump says we’re low and dropping. Grab your umbrella and glucose tablets; there is a storm coming.

Sunday, May 06, 2007

Hypos in the trenches

Well, actually there is only one trench, and only one hypo, but Hypo in the trench doesn’t sound as dramatic.

Come to think of it, it isn’t much of a trench either. Rio and I are trying to lay a phone line between the lab building and the house. The distance is about 500 feet, maybe 800. I’m not sure. To refresh your memory, we live on rock. Literally.

So our trench is more like a scratch. I scrape about half an inch of topsoil off with a pick, then lay the line in, cover it with pieces of rock, and then scrape some more dirt off the top of the bed rock nearby and throw it on top of the line. Pretty pathetic, but it’ll keep pack rats from chewing through the cord like happened to my short-lived internet extension. Or from being baked brittle by the relentless high-altitude southwestern sunlight, which can take the paint off of a soda can in weeks.

Rio? He has come to “help,” equipped with a pre-schooler sized shovel and a GIANT Tonka dump truck. He fills the truck up with his shovel, then tows the truck into place using a twenty foot piece of wire. Then he dumps the dirt on top of the trench. Or on top of my shoes. Whatever.

It’s a nice day. Cool and windy. Pretty soon I’ve worked up a pretty good sweat. It occurs to me that although I’m not much of a blue collar guy, the work isn’t that hard. And I’ve been running on the high side since morning….. but…..

I slide ParaPump out of her holster and press the ESC button to view the latest Sensor Glucose and the three hour graph. 122 with two “down” arrow icons. We’re dropping. And fast. Not too low to worry yet. Let’s see if we can get a few more yards.

Five minutes later:

116 with two downs.

Then 106. Time for a fingerstick, which will almost certainly be lower. We set down the pick, adult shovel, kiddie shovel, hoe and wire spool. We park the dump truck under a juniper tree and make for the lab, home of the nearest Accu-Chek meter. It calls the game at 62. Damn.


Saturday, May 05, 2007

Lions, and tigers, and bears; oh my!

I am trying to decide between the Leopard, the Snake, or the Zebra. No, I’m not buying cowboy boots.

I’m checking out the new skins.

Skins are like wallpaper for your pump. I actually went to the MedT online store to buy that stuff that removes glue-gunk from your skin. Then I saw the skins.

They are vinyl and wrap around your pump to change its style, color, and funk factor. They are supposed to be easy to put on and take off. They are the temporary tattoo of pumping. And they are $9.99 per pop.

Some samples: Blue Electricity, Daisies (defiantly not me), Jelly Beans, Tie Dye, Flames, Crayons…pretty much something for everyone. Before I knew it I had three in my shopping cart. Then I came to my senses. First off, I actually like the way ParaPump looks. That said, I can’t resist something new. So I decided to treat my self to just one.

I like the snake the best, but it really doesn’t match the colors of my key pad with its blues and grays. Same is true for the Leopard, so I settle on Snake.

I’ll let you know how it looks when it arrives…

Friday, May 04, 2007

View from the top

Today I was on the top of the world. Not in a good way, either. ParaPump’s sensor screen maxes out at 300, so when you are above that, you get a flat line along the top of the graph. Reasonable enough. T-1s aren’t supposed to be up there. On the bright side, the Sensor Glucose number readout goes at least as high as 386. Probably higher, but I’m in no mood to test that particular theory.

I’m on my way back down the mountain now. I feel like I got beat-up by a biker gang. Or a group of Russian Sailors. Or a Canadian Ice Hockey team. I’m flushing the ketones out with glass after glass of water.

So with all this wonderfual technology at my disposal how did I get into this predicament? Good question. But it was not an ambush. I was able to watch the train wreck happen in REAL TIME.

I took bolus after bolus after bolus until the ParaPump was nearly dry. Just as I was thinking an ER visit was in my future, the ice broke.

The lesson? Even with the best of gear at our disposal, sometimes diabetes is what it is.

Thursday, May 03, 2007

Pumping 104

I don’t know why I’ve taken so long to talk more about one of the best, most revolutionary, make-your-life-worth-living aspects of the new ParaPump system. Oh wait. I do know. It is because it works soooooooooooo well I never give it a second thought. It is so out of sight it is out of my mind. It is so comfortable it forget I’m even wearing it.

Compared to its predecessors, it is nano technology. It is the sparrow descended from the T-Rex. It is the sexy, aerodynamic airplane of the future compared to the clunky C-47 transport our grandfathers used. It is the MiniLink Transmitter. (Honestly, who names these things? MedT should stick to making great medical devices and ask diabetics for help naming their products. I bet their ad agency doesn’t have a single member of our tribe working for them.)

Poor name aside, this is awesome technology. I’ll put my poor over-taxed brain on coming up with a new name later. But for now we’ll call it Mini.

Well, first, I need to point out that Mini is not blue. But its recharger is. Sigh. Mini is white. Well, maybe cream colored. I would have gone for silver. Or clear. Or clear-greyish-purple to match the sensor it snaps to. Or flesh tone. Ah-ha! But whose flesh, you ask? Well, fair question. But none of us are cream colored. Except albinos. I’m betting there aren’t too many T-1 diabetic albinos. For those few of you out there, you’re gonna love the color of this transmitter. Maybe the engineers figured it would be covered with tape of some sort. Actually, tape is optional. That said, I’m superstitious and I’ve been putting an IV-3000 dressing over mine to hold everything securely in place. The transmitter does not have any sort of sticky pad like the old one. It just clips to the sensor, which does have some tape on it. Of course, the IV-3000 is clear.

So back to skin color. I vote for the color of Chinese skin. After all, there are more of them than any other kind of folk, right? A nice warm tan color looks better on white skin than cream-colored. Would more or less match Asians, Indians, and Hispanics. Would still be better than cream colored on Africans and African Americans.

But that’s honestly the only negative thing I can say about it. It could be blaze orange or neon pink and I would still love it. And you’ll love it too.

It is small, light, and curvy. Your underwear will not stick to it. It will not wake you up when you toss in your sleep. You can wear your red leather disco pants and no one will ask if you have a transmitter in your pocket or are you just glad to see them.

On top of all that, it works better. I rarely lose signal. Much more rarely than with the old transmitter. And did I mention that it is rechargeable? And what a cool little re-charger too. Like those save-your-ass emergency cell phone re-chargers it takes a common, humble AAA battery. You just slip the mini into the re-charger and a few hours buys you days, and days, and days… I’ve never run it down yet, and I’ve just been giving it little toots of power between sensors.

The transmitter is incredible. It--along with the generally very fine and accurate sensor that it plugs into--will make CGM a realistic technology that diabetes big and small will truly embrace.

There is competition on the horizon for MedT sensors, but assuming (with no evidence yet) that the sensors themselves share the same level of accuracy, this transmitter will cause MedT to win the race. I would rather wear a small transmitter and live with the various “issues” I have with the device than wear a larger transmitter and have a perfect device. I can say from experience wearing big transmitters and now a tiny one, David will triumph over Goliath once again.

Wednesday, May 02, 2007

Pumping 103

Ummmmm….. you prime a flintlock, right? And you prime a well. And we all know that prime rib is the most expensive thing on the menu. And if the prime rate goes up, God help you if you have a variable rate mortgage.

So what the heck has prime got to do with pumping insulin? Well, the prime menu in the ParaPump controls all of the functions of loading a freshly filled reservoir for its three day run. You also use a prime feature to “top off” your hose level every time you hook back up after showers and, allegedly, intimate moments.

Prime is how you fill the hose with insulin. Before you prime you have to rewind. When you remove a nearly empty reservoir you simply go to the prime menu and select rewind. The pump makes little whirring noises and the plunger arm (my term, not necessarily theirs) literally rewinds to make room for a full reservoir. To clarify, the reservoir has a plunger like a syringe. To pump insulin, the pump advances the plunger very small amounts to force the insulin up the hose and ultimately into your body. Once the reservoir is nearly empty the arm that pushes the plunger up is nearly to the top of the reservoir. If you just popped out the empty and shoved a full one into the pump all of the insulin would spurt through the hose and spill on to the floor. Or into you, if you were foolish enough to hook up pre-maturely. A 176 unit bolus would be very bad news indeed.

Thus, rewind before you prime.

Once you rewind, just drop the reservoir into the pump, half turn to lock it in and you are ready to prime. With the CoZmo, the prime, or “fill tubing” in CoZspeak, is turned on by pressing a button. It keeps going until you press a button again to stop it. In theory. In fact, I’ve dumped untold units of insulin on the floor trying to shut the damn thing off. So kudos to MedT this time. With the ParaPump you need to hold a button down to activate the priming. When you let go it stops. Oh yeah. This is better.

Prime the air out of the hose, and any stray bubbles too. You know, it occurs to me that I’m a bit out of sequence here. You do all of this stuff BEFORE you insert the set. Huh. Don’t know how I messed up that. Oh well.

So the proper order is: IV Prep your skin. Rewind pump. While it is rewinding, attach an insulin vial to the space dock collar of the reservoir. Fill ‘er up. Connect hose to reservoir. Give a manual squirt to start the juice down the hose. Put reservoir in now-rewound pump. Lock in place. Prime until drip, drip, drip. Put set in Quick-serter. Peel off backing paper. Cock device. Remove blue needle guard. Position serter. Fire! Lift serter off. Press gently down to make sure the set is in place. Pull needle. Now a fixed prime to fill the canaula. Go eat a pizza. Oh, dual wave is best for pizza.

Next time: Tinkerbelle transmitter

Tuesday, May 01, 2007

This is not a drill

Bong! The intercom on my phone comes to life, “lock your doors and do not leave your work areas. The clinic is on lock-down.” Holy shit.

A drill? Not taking any chances, I slip out of my office and lock the front door to the annex. Then I scoot back into my office and call the front desk. “Que paso?”

“One of the patients has gone nuts,” the front desk girl tells me, “we got him out into the parking lot, so stay put, we’ve called the cops.”

So I hunker down. Double check the second annex door, which was unlocked too. I bolt it and I close the front window blinds, then close my office door for good measure. Next I sit at my desk contemplating how bullet proof or un-bullet proof my walls are. Should I just sit here or should I make the phone call I was going to make? Or should I hide under my desk?

Very weird situation to be in. I’m not really scared at all. I feel more…. Useless. Out of a staff of about 25, six men work at the clinic, including myself. Shouldn’t I be on the frontlines? Well, I should do what I was told to do. If they need me they’ll call me.

I look at my hands, they are trembling. Adrenaline or hypo? Quick look at ParaPump. Current SG 88. The three hour screen shows a slash from the top left of the screen to the bottom right. Three hours ago I was hyper at 276. That’s about a point per minute, a pretty good clip. I do a quick finger stick. 58 on the Accu-Chek. Damn. Wish I had the BD with me so I could confirm or refute the rumors of poor low-BG performance.

Well, doing my part to support BD anyway, I pop one of their Glucose Tablets into my mouth. Pleasant orange flavor, according to the box. What the hell. I sit on the floor. I’d feel stupid if I got shot sitting in my office chair during a lock down.

The BD tablets are large and flat. Three to a blister pack that is an inch wide, four inches long, and a quarter of an inch thick. More portable than cherry slices. I give them out to all of our insulin using patients, so I figured I should pratice what I preach. I’ve found the cherry slices give me too big a rebound, so I’m trying these at 5 carbs per. The flavor is pleasant, but consistancay is chalky. Kind of like those little round candies that came in rolls we had as kids…. sweet tarts. The consistency of sweet tarts.

A few shouts drift through the walls from the parking lot. Can’t make out who or what they are saying.

I’m supposed to ingest fifteen carbs, wait fifteen minutes, and retest. But 15 carbs is almost always too much for me, so I’ve only taken one five carb tab. My hands are shaking worse. Annoying. But glad the body works again. It has only been five minutes, but I check again. Down to 56. A second glucose tab. SG on the ParaPump is still dropping. The trace shows no sign of flattening out.

Now SG at 74. So when the hell is the low alarm going to go off? I thought I’d set it at 75. Trace leveling a little now, but I’ve clocked in at 72 on ParaPump. Still no alarm.

My phone squawks. “All clear.” One emergency over with. Now I’m the only one still in trouble.

I check the sensor settings on the menu. Ah…. For some stupid reason I’ve got my low alert set at 70. That’s an idiot place for it to be. I don’t remember doing that….once my hands stop shaking I’ll reset it. I’d love to set it for 90 for day time and 80 for night, but ParaPump only lets me choose one setting all day and all night. If I had been set at 90 this hypo wouldn’t have ambushed me and whacked me upside the head. That said, at 90 it’ll bug me for no good reason during the night. I’ll switch it to 80.

It is nice to have the screen to watch the SG, but when you get busy, it is easy to forget. I read that the new Guardian has slope alarms. I wish ParaPump did. Nice sounding feature. Mean time, the best work-around is a conservative alarm setting.

OK, SG has leveled out. Finger stick shows 103. Everything is going to be OK. Both for me and for everyone else here. No crazy men. No hypos. We can go back to providing for the health of others, and not fear for our own safety.